George faces long road to recovery

Team USA Basketball and the Indiana Pacers suffered a serious blow when All-Star small forward/shooting guard Paul George suffered a gruesome right lower leg fracture 23 seconds into the fourth quarter of an intrasquad showcase game in Las Vegas. The game was suspended after the stoppage.

The injury occurred as George was sprinting to block a shot by James Harden, jumped and landed awkwardly under the basket, fracturing his right tibia and fibula. His lower leg bent unnaturally to nearly 90 degrees as both bones obviously broke and he immediately fell to the ground. Teammates, coaches, family members and medical staff immediately went to his side. He was placed in a splint and transported via ambulance to a local hospital.

Although a full recovery could take close to a year, I see George eventually returning to form. Let's look closer at the injury and what it means for him long term.

This horrifying injury immediately brings to mind two other high-profile tibia fractures. Most recently, Louisville's Kevin Ware suffered a similar injury on March 23, 2013, in an Elite Eight game against Duke. He returned to the court eight months later but reinjured the leg after nine games, was subsequently redshirted and has since transferred to Georgia State.

Former Redskins quarterback Joe Theismann was the focal point of the NFL's "Most Shocking Moment in History," selected by viewers in an ESPN poll, when he fractured his tibia on "Monday Night Football" on Nov. 18, 1985. He suffered a compound fracture of his leg while being sacked by New York Giants Hall of Fame linebacker Lawrence Taylor at RFK Stadium in Washington, D.C. Theismann's fracture ended his career, as the nature of his injury led to delayed healing and eventual shortening of his leg.

So, what does George face on his journey back to the court? He should be having surgery in the very near future, which usually involves placing a metal rod down the middle of the tibia to align the bones and allow for healing. This will include a hospital stay of about a week. There are a number of possible complications that could negatively impact his recovery. The most serious complication is the possibility of nerve damage.

When the tibia and fibula break, the fracture ends are quite sharp. If the lower leg bends to the degree I observed in the injury video of George, the sharp spikes of bone can lacerate or stretch the nerves to the lower leg. When this occurs, nerve healing is variable and often incomplete, compromising a return to form. The next worrisome complication to consider is infection. It is being reported that George's injury was a compound or open fracture. This means the bones came through the skin. If significant soft tissue injury occurs, the risk of infection goes up dramatically. In turn, this can affect healing and result in necessary further surgical intervention to eradicate the infection.

Finally, George will be watched closely for compartment syndrome. This occurs when the pressure, caused by swelling, becomes so high in the lower leg that arterial blood can no longer pass into the injured area with the necessary oxygen and nutrients required by the tissues to survive. The treatment for this is another surgery, called a compartment release, to relieve the pressure and re-establish normal blood flow. These compartments are then left open and are closed later in a subsequent procedure when the danger has passed and the pressures have returned to normal.

Once the surgery is completed, surgeons will quickly be able to determine the health of the nerves. Compartment pressures will be monitored frequently to protect George from the sequela of this complication, and it will be weeks before we can be sure that infection is no longer an issue.

When can George expect to get back on the court, and will he be able to return to his All-Star level of performance? A review of the literature shows that the bone should heal within 4-5 months with a return to the court probable in 8-12 months. It is possible for a return as early as six months, but I would expect the Pacers to be as cautious with George's rehab as the Bulls have been with Derrick Rose's recovery. That said, I expect the Pacers to be without George next season as they try to ensure a 100 percent return to form for the 2015-2016 season. Given George's age and level of fitness, if given adequate healing time and barring complication, I fully expect him to be playing at an elite level by midseason upon his return.